In-home support services said 'riddled with inefficiencies'

SAN DIEGO -- A county grand jury report released Thursday said a
massive county-coordinated program aimed at helping sick, disabled,
frail and elderly persons stay in their homes and out of
institutions was "riddled with inefficiencies" and used words such
as "abuse" and "stealing."

The report did not cite any instances of physical or criminal
abuse by caregivers, but said that elderly clients had a difficult
time navigating a bureaucratic system that poorly served them, and
that there was evidence that caregivers cheated on their hours and
were careless.

The report called on San Diego County health officials to do a
better job monitoring the program, known as "in-home support
services," to require monitors to report all abuses to adult
protective services for investigation. The program is mandated and
paid for by the state. The county oversees its operation although
the patients themselves handle much of the day-to-day interactions
with caregivers.

The report also calls on the county to improve its background
check system and to work with the county district attorney's office
to train staff members to recognize signs of elder abuse.

Pamela Smith, head of the county's aging and independent
services, said county officials took "great exception" to a report
they said was not fair.

"We have grave concerns about this report," she said. "We felt
it has a lot of inaccuracies and problems, and because of that, has
no value."

Smith said the county did not believe that the grand jury
understood the program, which is funded and regulated by the state,
or the county's limited role in coordinating it. She also said that
although the program has 23,000 clients, the report mentioned just
five incidences of problems. Those ranged from one senior not
learning of eligibility for the program for months to another
seriously ill client experiencing trouble communicating with his
caregiver because the caregiver didn't speak fluent English.

Smith said that under state regulations, the program's
low-income clients are responsible for hiring, overseeing, and
firing their own caregivers, of which roughly two-thirds are often
family members. She said the program did a great job of helping
elderly people stay in their homes, and was considered a "model"
program around the state.

Grand jury foreman David Higgins said Thursday by telephone that
investigators did not uncover any instances of physical elder
abuse.

Instead, Higgins said, investigators received anecdotal evidence
that elderly clients in the program had great difficulty dealing
with interviewing, hiring, keeping track of hours caregivers
worked, and other parts of the program.

Higgins would not say how many clients were actually
interviewed, saying it would compromise the confidentiality of the
grand jury process.

"What we saw were a lot of marginally functional or impaired
seniors trying to navigate a system so unfriendly and so
unsupportive that they sometimes just gave up … and lived in fear
of losing what little care they get if they complained."

However, Higgins said the grand jury found that the county was
completely complying with state regulations regarding the
program.

"It's definitely true that they are living up to their mandates
that the state imposes upon them," Higgins said. "We don't think,
given the complexity of the issue, that that's adequate."

He also said that he was disappointed that county officials
would suggest that the report's listing of five incidences of
problems was "OK" because it was a small number compared to the
program's size.

The grand jury report suggested that some in-home support
caregivers didn't show up to work on time, were indifferent to the
care they were supposed to provide, and left work early.

The report stated, "Caregivers who abuse the system by cheating
on work hours and services rendered are, in effect, stealing from
the Federal, State and County governments, as well as taxpayers.
This must be stopped."

Higgins said, "The testimony we're getting is that this is
widespread."

Among the recommendations included in the grand jury report was
that the county should expand the background check it does on its
registry of caregivers. Currently, that backgrounding checks to see
if caregivers have a criminal history in California -- but not in
other states.

The report also called on the district attorney's office to
increase its investigative staff to help prosecute "those who prey
on the elderly."

District attorney officials did not return a telephone call
seeking an interview.

The county grand jury does not have the authority to compel
agencies to follow any of its recommendations.

However, agencies that are part of grand jury investigations are
legally required to respond officially to an investigative report's
findings -- in this case, within 60 days.

The report stated that the county-coordinated in-home support
services had a $244.7 million budget in 2007-08 and that
approximately 19,500 clients receive nearly 80 hours of support a
month.